The role of imaging in acute aortic syndromes

The classic entity of life-threatening aortic dissection represents one pathology of a spectrum of acute conditions coined the acute aortic syndrome comprising dissection, intramural haematoma, penetrating atherosclerotic ulcer, and contained aortic rupture of any cause. The common denominator is disruption of the aortic media layers associated with severe pain and a variety of other symptoms. Any clinical suspicion of acute aortic syndrome should prompt immediate action and confirmatory non-invasive imaging; with respect to sensitivity and specificity for acute aortic pathology modern contrast-enhanced CT technology, MR imaging and ultrasound techniques have similar diagnostic accuracy near 100%. Since the prognosis of most patients with acute aortic dissection is related to undelayed diagnosis and (often surgical) treatment swift diagnostic imaging should be the primary goal in the work-up of any patient with suspected acute aortic syndrome; transfer and in-hospital logistics and local expertise for the differential use of various imaging modalities should be constantly improved.